Precocious or Early Puberty Development

Puberty is a phase of rapid growth and development that involves physical growth and sexual maturation, along with psychological and social development. The normal age of puberty in girls is 8-12 years whereas in boys it is 10-14 years. Precocious puberty refers to early puberty.

The signs of precocious puberty in girls include:

Breast development

Menstrual cycle

Appearance of underarm and pubic hair

Rapid growth such as increase in height

Acne

The signs of precocious puberty in boys include:

Deepening of voice

Appearance of underarm, chest, facial and pubic hair

Rapid growth such as increase in height

Enlarged penis and testes

Acne

Generally puberty is a result of increased hormonal levels in the body, stimulated by the hypothalamic-pituitary-gonadal axis. This stimulation triggers the hypothalamus to secrete gonadotropin-releasing hormone (GnRH). In response to GnRH, the pituitary gland starts releasing luteinizing hormone (LH), which induces the special cells present in the testes and ovaries to produce sex hormones, i.e. testosterone and estrogen respectively. The increased levels of the specific sex hormones are responsible for the development of secondary sexual characteristics.

Based on the cause of increased hormonal secretion, precocious puberty can be categorized as:

In central precocious puberty, underlying causes responsible for precocious puberty remain unidentified. The majority of patients, suffering from this condition, are medically fit, without any identifiable cause for early puberty. In rare cases, central precocious puberty may be secondary to any of the following conditions:

Hypothyroidism- a condition characterized by decreased hormonal secretion by the thyroid gland

Congenital adrenal hyperplasia- an inherited disorder characterized by dysfunctioning of the adrenal glands

Peripheral precocious puberty (PPP) is a less common condition, in which the Gn-RH is not involved in triggering early puberty. In PPP there is an increased level of sex hormones, i.e. testosterone and estrogen, secondary to:

Tumor in the adrenal or pituitary gland

McCune-Albright syndrome

Use of creams or ointments containing ingredient which may metabolize to estrogen or testosterone

Gene mutation- defect in the gene that produces testosterone in 1-4 year old boys

Complications

The possible complications of precocious puberty are as follows:

Short height: due to early release of the hormones the growth plate fuses and further growth stops

Social and emotional problems: early puberty generates depression, loss of self-esteem and substance abuse

Diagnosis

The diagnosis of precocious puberty involves physical examination, family history and medical history of the child. The bone growth can be assessed by X-rays of the wrist bone, for evaluation of normal growth. Gn-RH Stimulation test is recommended for determining the type of precocious puberty. The additional tests that may be employed for testing CPP include MRI scan of the brain and thyroid testing, whereas for PPP additional tests may include certain blood tests and ultrasound for detecting ovarian cysts or tumors.

Treatment

The treatment of central precocious puberty involves certain medications, called Gn-RH analogue therapy, that delay the onset of puberty. In peripheral precocious puberty the underlying medical condition causing puberty also needs to be treated. The treatment may include surgical removal of the tumor, which is causing precocious puberty.